Objective To evaluate the incidence of central line-associated bloodstream infection(CLABSI) among critically ill children, and provide basis for making preventive and control measures.Methods Prospective surveillance was performed to monitor CLABSI among children (including neonates) with central lines in 7 children's intensive care units(ICUs) from January 2012 to December 2015.Results Of 37 712 hospitalized patients, the overall length of hospital stay were 268 531 days, the overall central line-day was 57 639, utilization rate of central line was 21.46%;126 patients had CLABSI, CLABSI rate per 1 000 central line-days was 2.19, there was no significant difference in the CLABSI rate among each year(P>0.05);CLABSI rate in the third quarter was higher than that in other quarters(all P<0.05,compared with the first quarter,RR[95%CI]=1.98[1.20, 3.29]);CLABSI rates were different among different types of ICUs, surgical neonatal ICU (SNICU)(6.12/1 000 central line-days) was higher than other types of ICUs (all P<0.05, compared with pediatric ICUs[PICUs], RR[95%CI]=3.02[1.51-6.04]).126 patients with CLABSI were isolated 139 strains of pathogenic bacteria, the main pathogens were Klebsiella pneumoniae (20.86%) and Staphylococcus epidermidis (15.83%).Conclusion Critically ill children in SNICU are high risk population of CLABSI infection, intensified intervention measures should be developed for the department , so as to reduce CLABSI effectively.

Objective To explore the incidence of nosocomial infection in a neonatal intensive care unit(NICU) so as to come out with scientific and effective measures for infection control. Method Real-time monitoring system was used for investigating nosocomial infection of ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and central-line associated bloodstream infection (CLABSI) in NICU. Results Among 2 836 patients, 28 patients were infected, with the rate of 0.99%and the case-time infection rate of 1.09%. The nosocomial infection manifested to be blood infection with the rate of 35.48%, and 10%of main pathogens were gram-negative bacteria. Conclusions Targeted monitoring in NICU can make the nosocomial infection information acquired timely, objectively and accurately. The strict and intensified prevention and control program should be adopted to reduce the neonatal nosocomial infection.

Objective To investigate the hygienic status of large bottles of medical ultrasonic coupling gel in medical institution.Methods From February 2012 to April 2016, microbial contamination of large bottles of medical ultrasonic coupling gel in a women and children''s hospital was investigated and analyzed through on-the-spot random sampling and detection method.Results A total of 170 large bottles of medical ultrasonic coupling gel specimens were collected, 25 specimens were qualified, the qualified rate was 14.71％.Specimens were mainly from inpatient wards(58.24％) and operating departments(21.76％);there was no statistical difference in the qualified rate of specimens in each department(P>0.05).Contamination rates of coupling gel before and after the opening were both>80％, difference was not significant(P>0.05).A total of 145 strains of pathogenic bacteria were isolated, 18 of which were from unopened bottles, and 127 from opened bottles.Burkholderia cepacia was the main strain in both unopened and opened bottles, which accounting for 83.33％ and 54.33％ respectively,in addition, Pseudomonas aeruginosa and Serratia marcescens were also isolated from opened bottles, both were 15.75％, mixed contamination bacteria all included Serratia marcescens Conclusion The total bacteria counts in medical ultrasonic coupling gel in large bottles exceed the standard seriously, the manufacturer should strictly observe the quality control standards, medical institutions should adopt effective cleaning and disinfection measures.

Objective To investigate the prevalence of healthcare-associated infection(HAI)in a children's spe-cialty hospital in Guangzhou in 2014.Methods A cross-sectional survey was undertaken to investigate the preva-lence of HAI among all hospitalized patients on September 17,2014.Results A total of 997 patients were investiga-ted,30 patients developed 32 times of HAI,HAI rate and HAI case rate were 3.01% and 3.21% respectively. The main infection sites were upper respiratory tract(n= 11,34.38% );the departments with higher HAI prevalence rates were intensive care unit(ICU,3 .99% )and pediatric internal medicine department(3 .60% );the rate of etio-logical examination in patients with HAI accounted for 93 .33% ,a total of 24 strains of pathogens were isolated,6 of which were virus (25 . 00% ),6 were fungi (25 . 00% ),11 were bacteria (45 . 83% ),and 1 was Chlamydia (4.17% ). The main bacteria were Staphylococcusaureus (n= 3,27.27% )and Staphylococcusepidermidis (n= 3, 27.27% );a total of 451 (45.24% )patients received antimicrobial agents on the investigation day,67.41% of whom received therapeutic use of antimicrobial agents,19.73% received prophylactic use,and 12.86% received both therapeutic and prophylactic use;mono-drug application accounted for 82 .26% ,the percentage of bacterial de-tection among patients with therapeutic antimicrobial use (including combination of therapeutic and prophylactic use)was 82.60% .Conclusion Management of key departments and key sites of HAI should be strengthened in children's specialty hospital,antimicrobial agents should be used rationally,so as to protect the safety of children.

Objective:To evaluate the correlation between the timed up and go(TUG)test and fall risks in elderly frail patients.Methods:From July to September 2019, elderly frail patients who were treated at the cardiovascular department of our hospital were enrolled.Basic clinical data and fall-related information of patients were collected.Patients were divided into the fall group and the non-fall group.Results on the body mass index(BMI), TUG, 4-meter maximum walking speed(4 m MWS)and Barthel index were compared between the two groups.The correlation between TUG and each indicator was examined.Multivariate Logistic regression analysis was used to analyze the correlation between the TUG and falls in elderly patients.Results:A total of 96 eligible patients were enrolled, including 35 in the fall group and 61 in the non-fall group.The average TUG time was longer in the fall group than in the non-fall group(16.45±6.44 s vs.10.17±2.91 s, t=-6.556, P<0.001). The correlation analysis results showed that the TUG was correlated with falls and 4 m MWS( r=0.582 and 0.875, both P<0.001). Multivariate Logistic regression analysis showed that the TUG( OR=1.201, 95% CI: 1.111-1.470, P=0.004)and 4 m MWS( OR=1.146, 95% CI: 1.063-1.244, P=0.015)were risk factors for falls. Conclusions:The TUG is correlated with fall risks in elderly frail patients and should be recommended as a routine test in clinical practice.

OBJECTIVETo investigate the mechanical characteristics of new type two-head automatic pressure external fixator in the view of biomechanics.

METHODSFifteen fresh and humid specimens were selected and divided into experimental group (5 cases) and control group (10 cases). The control group were respectively applied with DHS (5 cases) and traditional external fixator (5 cases). In order to compare the different apparatus, the strength, stiffness and twist mechanical function of femoral intertrochanteric fracture with different device were measured respectively when the specimens were under the pressure of 0-1800 N and loading speed 1.4 mn/min.

RESULTSThe strength, stiffness, twist mechanical function and maximum endurance of femora in the experimental group were obviously superior than that of DHS and traditional external fixator (P < 0.05).

CONCLUSIONTwo head automatic new type pressure external fixator can embed more tightly without sliding, also can prevent the occurrence of coxa vara effectively.

External Fixators ; Femoral Fractures ; surgery ; Fracture Fixation ; instrumentation ; methods ; Humans ; Stress, Mechanical

OBJECTIVETo design a new type two-head automatic pressure external fixator and explore its clinical effects in treating intertrochanteric fracture of the femur.

METHODSBase on unilateral angulated external fixator and Ilizarov techiques, a new type two-head automatic pressure external fixator were designed and made. From October 2006 to December 2010, 120 patients with intertrochanteric fracture of the femur were treated with the new type two-head automatic pressure external fixator. There were 67 males and 53 females with an average age of 76.7 years (ranged, 60 to 93 years). According to Evans classification, type I was in 65 cases, type II in 41, type III a in 10, type III b in 2 and type IV in 2. Operative time was from 0 to 11 days after injury with an average 5 days. Postoperative functional recovery was evaluated according to criteria of Sanders.

RESULTSAmong 120 patients, 116 cases were followed up with an average of 12 months (ranged, 2 to 24 months). All fractures obtained healing with average healing time of 12 weeks (ranged, 10 to 13 weeks). Five cases occurred with superficial infection of pin site and no deep infection,non-union, coxa adducta were found. Joint function of hip recovered well. According to Sanders scoring, pain, walking, function, muscle strength, daily activities and X-ray estimate were respectively (9.07 +/- 0.41), (9.23 +/- 1.00), (9.42 +/- 1.10), (9.31 +/- 1.06), (9.22 +/- 1.03), (10.00 +/- 0.00) with total amount of (56.27 +/- 4.16). A hundred and six cases got an excellent results, 6 good, 4 poor.

CONCLUSIONThe new type two-head automatic pressure external fixator is easy and convenient to apply in operation. It has duplicate functions of load and minimal invasive. It is an ideal method for treatment of the intertrochanteric fracture of the femur in high-risk and senile patients.

Aged ; Aged, 80 and over ; External Fixators ; Female ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Hip Fractures ; surgery ; Humans ; Male ; Middle Aged ; Prosthesis Design

Objective: To explore the relative risks of rotavirus diarrhea after exposure to different levels of atmospheric pressure in children in Guangzhou City, so as to provide reference for improving public awareness of high atmospheric pressure exposure. Methods: The study used the China Notifiable Communicable Diseases Network System and China Meteorological Science Data Sharing Service Network to collect meteorological data and data relating to daily cases of rotavirus diarrhea in children at Guangzhou Women and Children s Medical Center from 2012 to 2020. The association between rotavirus diarrhea and atmospheric pressure was analyzed using distributed lag non linear models (DLNM). The relative risks of different sex and age sub groups exposed to different atmospheric pressures were also evaluated. Results: A total of 18 587 cases of rotavirus diarrhea were reported from 2012 to 2020, among which 11 662 cases (62.7%) were boys, and 12 582 cases (67.7%) were children aged 6 to 24 months old, which represented the highest proportion. The results of the DLNM showed that the relative risk of rotavirus diarrhea was the highest on the day of exposure to extreme high atmospheric pressure ( RR =1.50, 95% CI =1.24-1.82, P <0.05) and the effect could last for 28 days. Risk of rotavirus diarrhea was low for exposure to low pressure within 2 weeks ( P <0.05). During extremely high atmospheric pressure weather, RR was higher in girls ( RR =3.31, 95% CI =1.46-7.49， P <0.05) than that in boys ( RR =1.98, 95% CI =0.96-4.07， P >0.05). Among different age sub groups, RR was the highest in children aged 24 to 60 months after exposure to the highest level of atmospheric pressure exposure ( RR =3.36, 95% CI =1.27-8.89, P <0.05). Conclusion In Guangzhou, exposure to high pressure increases the risk of rotavirus diarrhea in children. In the future, public awareness should be raised regarding the risk after exposure to high atmospheric pressure.

Objective To explore the association between the different forms of in vivo ghrelin—Acyl ghrelin( AG) ,Des-acyl ghrelin( DAG) and AG/DAG with insulin resistance( IR) in patients with type 2 diabetes mellitus. Methods From June 2017 to November 2017,eighty-three patients with type 2 diabetes hospitalized in (group T2DM) and 40 healthy subjects (group NC) were hospitalized in Jinling Clinical Medicine were selected. Height body mass,blood pressure,blood lipid,glycated hemoglobin ( HbA1c) and fasting blood glucose (FPG),fasting insulin (FINS),and fasting C peptide (F-C-p) were measured,and all subjects were left with fasting serum,and the concentration of AG and DAG were measured by enzyme linked immunosorbent assay (ELISA). The body mass index (BMI),total gastric starvation (T-ghrelin) level,AG/DAG,insulin resistance index ( HOMA-IR) , insulin sensitivity index ( HOMA-IS ) and islet beta cell function ( HOMA- beta ) were calculated. The differences of the above indexes between the two groups were compared, and the relationship between AG,DAG,T-ghrelin,AG/DAG and FPG,HOMA-IR,HOMA-IS and HOMA- beta in T2DM patients were analyzed. Results ( 1) There were no significant difference in SBP、DBP、TC、LDL-C、AG between group NC and group T2DM(P>0. 05). Compared with NC group,the age、TG、BMI、HbA1c、FPG、FINS、HOMA-IR、HOMA-β、AG/DAG were significantly higher in T2DM group ( t=2. 690,-1. 990, 0. 873, 14. 257, 10. 528, Z=2. 885,-3. 483,-2. 284;P<0. 01,P<0. 05) . The HDL-C,F-C-p,HOMA-IS,HOMA-beta,DAG and T-ghrelin in group T2DM were lower than those of NC group( t or Z=0. 477,-3. 812,-3. 395,-4. 4,-2. 916,-2. 834;P<0. 05 or P<0. 01) . ( 2) The correlation analysis showed that there was a positive correlation between AG and FPG in T2DM group (r=0. 252,P<0. 05),DAG and T-ghrelin were negatively correlated with HOMA-IR (r=-0. 394,-0. 384,P<0. 05),and AG/DAG was positively correlated with HOMA-IR (r=0. 394,0. 384,P<0. 05),but is negatively correlated with HOMA-IS (r=-0. 292,P<0. 05). (3) multivariate linear regression analysis showed that FPG in T2DM patients were the influencing factors of AG ( t=2. 865,P<0. 05) ,while FINS and BMI were the influencing factors of DAG( t=-2. 808、-0. 330,P<0. 05) andT-ghrelin( t=-2. 725、-0. 330, P<0. 05) . HOMA-IR and BMI are the influencing factors of AG/DAG ( t=3. 718,3. 069,P<0. 05) . Conclusion The levels of DAG and T-ghrelin in group T2DM were significantly lower than those in the normal population, and was negatively correlated with the insulin resistance index,and the ratio of AG/DAG was closely related to insulin resistance,and the level of AG was mainly affected by fasting blood glucose.

Objective:To assess the relationship between body mass index (BMI) and death risk of cardiovascular disease (CVD) in rural male population.Methods:22 282 men aged 40 years older in Tanghe county and Fenghuang county from the cohort of the "Prospective Study on Adult Behavior and Health Risk Factors in China" were selected as subjects of this study. Cox regression model was used to calculate the hazard ratios ( HRs) of the death of CVD during the follow-up period with different BMI groups at baseline. Results:The average follow-up period in the two counties was (19.1±8.7) years and 10 828 (48.6%) people died during the follow-up period. 4 504 deaths were attributed to CVD. Among the deaths of CVD, 1 279 cases died of ischemic heart disease (IHD), ischemic stroke (IS) died in 1 201, cases died of died of 1 317 hemorrhagic stroke (HS), other 707 cases. Compared to population with BMI<18 kg/m 2, Cox regression model (adjusting factors of region, age, nationality, education level, occupation, smoking, drinking, blood pressure, blood pressure, etc.) showed that people with BMI between 20-22 kg/m 2 had the lowest risk of CVD death ( HR=0.95, 95 %CI: 0.83-1.09). But the difference was not statistically significant among each BMI group ( P>0.05). The risk of IHD death was the lowest in the population with BMI between 20-22 kg/m 2 ( P<0.05) ( HR=0.64, 95 %CI: 0.52-0.80). There was no statistically significant difference between the risk of IHD death in the population with BMI≥24 kg/m 2 and that in the population with BMI<18 kg/m 2 ( P>0.05). There was no statistically significant difference between the risk of IS death and BMI ( P>0.05). The death risk of HS in the population with BMI between 18-24 kg/m 2 was higher than that in the population with BMI<18 kg/m 2 ( P<0.05). The death risk of the population with BMI between 26-28 kg/m 2 was the highest ( HR=1.88, 95 %CI:1.18-2.99). Conclusions:The mortality risk of CVD and IHD was the lowest in lean or normal weight group, and HS was higher in overweight group. Maintaining a reasonable weight can reduce the risk of death in patients with CVD.